What is Hearing Loss?
Hearing Loss is what happens when a part of the ear (outer, middle, and/or inner ear) is missing, misshaped, or damaged.
Hearing problems may be present at birth (congenital) or develop later in life (acquired).
Some children can hear in one ear, but not the other, this is known as a unilateral hearing loss.
Some children have problems in both ears, known as a bilateral hearing loss.
How the ear and hearing works
- Ear canal: Sound moves through the ear canal and strikes the eardrum.
- Eardrum and bones: Sound waves cause the eardrum to vibrate, sending the bones in the middle ear into motion. The tiny bones are called the malleus (hammer), incus (anvil) and stapes (stirrup).
- Inner ear: This motion causes the fluid inside the inner ear (cochlea) to move the hair cells.
- Hearing nerve: Hair cells change the movement into electric impulses, which are sent from the hearing nerve into the brain. Your child hears sound.
Types and causes of hearing loss
- Conductive Hearing Loss: A problem in the outer or middle ear (eardrum and three tiny bones). Outer or middle ear infections, birth defects, head injury, perforated eardrum, and foreign bodies in the ear may cause conductive hearing loss in children.
- Sensorineural Hearing Loss: A problem in the inner ear (cochlea and/or auditory nerve). Genetics, head injury, some medications (inner ear hair cells are damaged), and meningitis, may cause sensorineural hearing loss in children.
- Mixed Hearing Loss: A combination of conductive and sensorineural hearing loss.
There are 4 degrees of hearing loss which your audiologist will use to explain your child’s hearing loss:
- Mild – unable to hear soft sounds, difficulty perceiving speech in noisy environments.
- Moderate – unable to hear soft and moderately loud sounds, considerable difficulty in perceiving speech, particularly with background noise.
- Severe – speakers must raise their voice. Group conversation is possible only with considerable effort.
- Profound – some loud sounds are audible but communication without a hearing instrument is impossible.
Children with Hearing Loss
Children with hearing loss could find it difficult to develop normal speech and language. Children with hearing loss often learn to compensate for the lack of hearing normal sounds by using their other senses to gain information about the world around them. They may feel the vibrations of someone walking toward them, or the changes in air flow when a door is opened. Changes in light intensity could also give a child clues to someone entering the room. Parents often find it difficult to see the signs and detect hearing loss in infants because their responses seem quite normal due to the use of other sensory clues.
Children are never to young to have their hearing tested, and the sooner a child’s hearing loss is identified and treated the better the chance for normal speech and language development and educational opportunities.
Signs of Hearing Loss in Infants and Children
- A lack of normal behavioural response to loud sounds. For example, a door slams and the infant/child does not startle.
- Does not respond to their own name. A normal hearing child should be able to respond by the age of 6 months.
- Failure to respond to simple commands. For example “give mummy the apple”.
- Inability to locate sounds. A child by the age of 6 months should be able to turn their head to the speaker.
- Aggressive or poor behaviour due to frustrations of not being able to hear clearly.
- Baby babbling begins to stop around 6 months of age.
- Baby babbling does not evolve into one word utterances.
- Pulling or touching their ears. This maybe due to pain or infection.
- Inappropriate responses to directions or commands.
Children suffering from hearing loss may experience
- Withdrawal from social activities and feel social isolation
- Problems with speech and language development
- Low self-esteem, emotional difficulties, and depression
- Problems learning at school or getting and keeping a job
- Appear inattentive, restless, or express their frustrations with poor behaviour
- Difficulty responding to speech from behind or soft speech
- Difficulty regulating their volume – either speak loudly or whisper while speaking
- A stop or delay in speech development compared to others of the same age
Communication development guide for parents with small children
- 0-4 months – appears startled by loud noises and settled by mother’s voice.
- 4-6 months – eyes move towards sounds and facial expressions change as a response to mother’s voice.
- 5-6 months – begins to make noises and appears to be communicating.
- 6-9 months – responds when name called and turns head towards sound.
- 9-12 months – can copy speech e.g. ‘mum’ & ‘dad’.
- 12-18 months – can say basic words and understand instructions.
- Over 18 months – vocabulary should increase reasonably quickly.
- By 1 year:
- Respond to and recognise familiar sounds such as the telephone ringing, the vacuum cleaner, or the car in the driveway
- Understand simple commands such as ‘no’
- Recognise their own name
- Understand the names of familiar objects and people
- Say ‘dad’ and ‘mum’
- Enjoy songs, music, and books
- By 2 years:
- Say names of simple body parts such as nose or tummy
- Listen to stories and say the names of pictures, understand simple sentences such as ‘where is your shoe?’
- Use more than fifty words such as ‘no’, ‘gone’, ‘mine’ and ‘teddy’
- Talk to themselves or their toys during play
- Sing simple songs, such as ‘twinkle, twinkle, little star’ and ‘baa, baa, black sheep’
- Use some pronouns instead of names such as ‘he’ and ‘it’
- Try simple sentences such as ‘milk all gone’
- By 3 years:
- Understand how objects are used – e.g. a crayon is something you draw with
- Recognise their own needs, such as hunger
- Follow directions
- Use three to four word sentences
- Begin using grammar
- Enjoy telling stories and asking questions
- Have favourite books and television programs
- Be understood by familiar adults
- By age 4 years:
- Understand shape and colour names
- Understand some ‘time’ words such as ‘lunch time’ and ‘today’
- Ask who, what, and why questions
- Use lots of words, about 900, usually in four to five word sentences
- Use correct grammar with occasional mistakes, such as ‘I falled down’
- Use language when playing with other children
- Speak clearly enough to be understood by most people
- By age 5 years:
- Understand opposites, such as high and low, wet and dry, big and little
- Use sentences of about six words with correct grammar
- Talk about events which are happening, have happened, or might happen
- Explain why something happens, such as ‘mum’s car stopped because the petrol ran out’
- Explain the function of objects
- Follow three directions, e.g. ‘stand up, get your shoes on, and wait by the door’
- Say how they feel and tell you their ideas
- Become interested in writing, numbers, and reading things
- Speak clearly enough to be understood by anyone
When should you get your child’s hearing tested?
The best way to prevent hearing problems affecting normal speech and language development and your child’s school performance is to detect the hearing loss as early as possible.
Children are never too young to have their hearing tested and the sooner a child’s hearing loss is identified and treated the better the chance for normal speech and language development and educational opportunities. It helps to seek support and advice about testing and diagnosis too.
What is a (Central) Auditory Processing Disorder in children?
Children with (C)APD will often experience difficulties understanding and interpreting auditory information (speech and language) with normal hearing. The auditory processing system is very complex and includes a number of very specific auditory skills to help us effectively “understand” and “hear” speech and language. The cause of (C)APD is often unknown however the condition can coexist or be mistaken for hearing, learning, attention, or language problems.
- Your child may have trouble paying attention to and remembering information presented orally
- Have low academic performance particularly in reading and spelling
- Have problems in carrying out multi-step tasks
- Seems to hear but not understand what people say
- Needs time to process the information
- Have difficulties understanding speech in the presence of any background noise
When should you get your child tested for (C)APD?
Children may be tested from the age of 7 years by an audiologist to identify the disorder. Ideally the management of (C)APD involves a team of professionals including audiologists, speech pathologists, educational psychologists, learning support teachers, paediatricians, and occupational therapists once the disorder has been identified.
– this article was kindly provided by Jenny Stevens, Clinical Director at Attune Hearing